No. 38909 (Amendment): Rule R428-1. Health Data Plan and Incorporated Documents

(Amendment)

DAR File No.: 38909
Filed: 10/15/2014 01:18:16 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this amendment is to update the version of one document incorporated by reference within Rule R428-1; specifically, change Utah All-Payer Claims Database Data Submission Guide from Version 2.0 to Version 2.1. Also, drop obsolete reference to Technical Specifications v 1.3 from the rule since the document is no longer used or needed.

Summary of the rule or change:

The changes update material incorporated by reference to reflect technical requirements expected for compliance beginning April 2015, in particular: 1) adding and requiring more data fields to allow the Department to comply with the legislative requirement of providing information for coordination of benefits (COB) project; and 2) editing language on required submissions from stand-alone dental carriers--a future requirement-- to have more clarity regarding the timing and process for eventually including stand-alone dental data into the All Payer Claims Database. The changes also remove unnecessary language.

State statutory or constitutional authorization for this rule:

• Title 26, Chapter 33a

This rule or change incorporates by reference the following material:

• Updates Utah All Payer Claims Database: Data Submission Guide, published by Utah Department of Health, 10/15/2014

Anticipated cost or savings to:

the state budget:

This rule amendment updates the version of data submittal manual for the All Payer Claims Database. The Utah Department of Health (UDOH) determines enactment of the amended version will not create any additional cost or savings impact to the state budget or UDOH's budget, since the change will not increase workload and can be carried out with existing budget.

local governments:

This filing does not create any direct cost or savings impact to local governments since they are not directly affected by the rule; nor are local governments indirectly impacted because the rule does not create a situation requiring services from local governments.

small businesses:

None--Small businesses are not impacted by this rule change, with all potentially impacted having more than 50 employees. As a result, the rule will have no effect on small business budgets for costs or savings.

persons other than small businesses, businesses, or local governmental entities:

The most significant change in this update is the addition of more fields to allow the Department to comply with the legislative requirement of providing information for the COB. Other changes have been identified as relatively minor and necessary to ensure usefulness of the data for required reporting. These changes are part of an annual updating process and we will continue to work with data suppliers to minimize the programming requirements. Overall cost to the health carrier industry--specifically to those currently required to comply with the Data Submittal Guide listed in Rule R428-1--will total approximately $252,000 (18 carriers x $14,000).

Compliance costs for affected persons:

This rule amendment adds new requirements to the current Data Submittal Guide enforced as of April 2015. Data submitters will need to comply with this guide by developing and implementing modest changes to their existing data systems. An increase to the submitter's budget and workload may be experienced, depending on how many modifications are needed to be made for compliance. It is estimated to cost $11,200 to $16,800 per data submitter to comply with changes to the guide, which may not include all necessary staff time. This range is based on an estimated amount of $14,000 per submitter for one FTE working approximately one month per Utah DTS price guidelines.

Comments by the department head on the fiscal impact the rule may have on businesses:

One of the purposes of this rule amendment is to support the statewide coordination of benefits (COB) project. The APCD data suppliers are participants in the COB project. Although there are estimated costs for each data supplier to update their technical programs of data submission, long-term benefits for the COB project participants may outweigh the initial cost of expanding data elements for the project.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Center for Health Data, Health Care Statistics
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Mike Martin at the above address, by phone at 801-538-9205, by FAX at 801-538-9916, or by Internet E-mail at [e-mail]
• Norman Thurston at the above address, by phone at 801-538-7052, by FAX at 801-237-0787, or by Internet E-mail at [e-mail]
• Stephanie Saperstein at the above address, by phone at 801-538-6430, by FAX at , or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

12/01/2014

This rule may become effective on:

12/08/2014

Authorized by:

David Patton, Executive Director

RULE TEXT

R428. Health, Center for Health Data, Health Care Statistics.

R428-1. Health Data Plan and Incorporated Documents.

R428-1-1. Legal Authority.

This rule is promulgated in accordance with Title 26, Chapter 33a.

 

R428-1-2. Purpose.

This rule adopts and incorporates documents related to the collection, analysis, and dissemination of data covered in this title.

 

R428-1-3. Health Data Plan Adoption.

As required by Section 26-33a-104, the Health Data Committee adopts by rule the health data plan dated October 3, 1991.

 

R428-1-4. Incorporation by Reference.

The following documents are adopted and incorporated by reference:

(1) Utah Hospital Inpatient Discharge Data Submittal Manual, Data Element Descriptions and Definitions, Version VI, February 2014

(2) Utah Ambulatory Surgical Submittal Manual, Data Element Descriptions and Definitions, Version III, November 2009

(3) HEDIS 2012, Volume 3, Specifications for Survey Measures published by NCQA

(4) 2014: Volume 5: HEDIS Compliance Audit: Standards, Policies, and Procedures published by NCQA

(5) [Technical Specifications and Data Submission Procedures for the State of Utah All Payer Database Version 1.3]Utah All-Payer Claims Database Data Submission Guide Version 2.0

(6) Utah All-Payer Claims Database Data Submission Guide Version 2.[0]1

 

KEY: health, health policy, health planning

Date of Enactment or Last Substantive Amendment: [August 5, ]2014

Notice of Continuation: November 21, 2011

Authorizing, and Implemented or Interpreted Law: 26-33a-104

 

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